in
fact, for me and in my name and stead, and to my use, for the purpose of
__________ __________________________________.

I
hereby give to my attorney full authority and power to do anything and
everything whatsoever required or obligated to be done, at least to the extent
I could or might do, with full power of substitution and revocation.I hereby confirm and sanction all that said
attorney shall lawfully do or cause to be done, acting on my behalf and in my
stead.